The Effect of Patient-Specific Instrumentation Incorporating an Extramedullary Tibial Guide on Operative Efficiency for Total Knee Arthroplasty.
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ABSTRACT:
SUBMITTER: Kwon OR
PROVIDER: S-EPMC5559926 | biostudies-other | 2017
REPOSITORIES: biostudies-other
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Project description:During total knee arthroplasty, balancing is necessary for long-term stability and longevity of implants as improper balancing leads to abnormal surface strain. A routine practice among surgeons is to add more posterior slope to the proximal tibia to provide an increase in the flexion gap to balance the knee throughout the entire range of motion, particularly when doing cruciate-retaining knees. The aim of this technique guide is to provide a simple estimate of the posterior slope added or subtracted when cutting the proximal tibia using a standard extramedullary guide. It can also be applied to predict the amount of coronal change instituted using a standard extramedullary drop guide. Using a few basic calculations with a sine equation, a surgeon can accurately predict the amount of change in the slope applied when cutting the proximal tibia. This can be done to control the degree of slope added to the anterior-posterior direction and can be used to predict coronal alignment changes as well. This technique can be applied to any length extramedullary guide and applied across all companies to provide surgeons with an exact degree change in the tibial slope and coronal alignment with simple calculations.
| S-EPMC7987928 | biostudies-literature
Project description:Anteroposterior radiographs that included the whole tibia were taken before and after 75 total knee arthroplasties in 48 patients. The same tibial extra-medullary alignment guide system was used in every knee. The average tibial component alignment was 0.4 (SD 2.5, range -4.9 to 6.4) degrees of valgus post-operatively. 59 tibial components (78.7%) had a tibial cut within 3 degrees from being perpendicular to the mechanical axis, ten were too valgus (13.3%) and six were too varus (8%). The chance of the tibial components becoming too varus was higher if there was lateral tibial bowing, compared with no tibial bowing (p=0.048). A smaller lateral width of the leg increased the chance of the tibial components becoming too valgus (p=0.047).
| S-EPMC2532261 | biostudies-other
Project description:BACKGROUND:The mobile Oxford unicompartmental knee arthroplasty (UKA) implant has been widely used with an intramedullary guide for femoral preparation. We modified the femoral guide technique based on the tibial cut first and spacer block technique. This study was performed to determine the radiographic accuracy and early clinical outcomes of the extramedullary method. METHODS:We retrospectively evaluated 50 consecutive patients who underwent UKA using the extramedullary technique. An equal number of patients who underwent UKA with the conventional technique were matched as the control group. Clinical outcomes were evaluated in terms of the operating time, blood loss, range of motion, and Hospital for Special Surgery score. Radiographic accuracy was evaluated by the implant position and alignment in the coronal and sagittal planes. RESULTS:The mean follow-up period was 39.76 ± 5.77?months. There were no differences in the postoperative Hospital for Special Surgery score, range of motion, or hip-knee-ankle angle between the two groups. The operating time in the extramedullary group was shorter than that in the conventional group (54.78 ± 7.95 vs. 59.14 ± 10.91?min, respectively; p = 0.025). The drop in hemoglobin after 3?days was only 12.34 ± 4.98?g/L in the extramedullary group which was less than that in the conventional group (p = 0.001). No significant differences were found in the postoperative coronal and sagittal angles between the two groups. Acceptable radiographic accuracy of the implant alignment and position was achieved in 92% of patients in the extramedullary group and 96% of patients in the conventional group. CONCLUSIONS:The radiographic and clinical results of the extramedullary technique were comparable with those of the conventional technique with the advantage of no intramedullary interruption, less blood loss, a shorter operating time, and more rapid recovery. As the technique depends on the accurate tibial cut and overall alignment, we do not recommend it to surgeons without high volume experiences. TRIAL REGISTRATION:Retrospectively registered LEVEL OF EVIDENCE: IV, retrospective study.
| S-EPMC7057495 | biostudies-literature
Project description:BackgroundIntraoperative fracture during primary Total Knee Arthroplasty (TKA) is very rare and there is little literature available which has defined the possible reasons for the occurrence of these fractures. Further, no study till date has defined the various management options available to treat these fractures. This study aims to define (1) the possible reasons for different fracture patterns occurring intraoperatively, (2) the ideal management options for each type of fracture geometry, (3) whether this intraoperative complication affects the physiotherapy protocol and long term outcomes.MethodsOut of 3168 primary TKA done between 2010 and 2017, 19 patients developed intraoperative fracture, whose data was evaluated retrospectively. Patients were assessed radiologically to determine the time to union and clinical outcomes were assessed using Knee Society Score.ResultsOut of the 19 intraoperative fractures, 19 were in Tibia and 4 in Femur. Majority of fractures occurred during cementing and final implantation (8 cases), followed by exposure and bone preparation (6 cases) and the least during trialing (4 cases). Out of 15 Tibia fracture, 9 fractures involved the Tibial cortex which were managed with screws (4 cases), sutures and bone cement (5 cases). Stemmed tibial component was used for all Plateau type fracture patterns (6 cases). Out of 4 distal femur fractures, condylar type fracture pattern were fixed with plates and screws (3 cases) and epicondyle avulsion with screws alone (1 case). All the cases showed union (average union time 8.9 weeks) and good KSS scores which remained till their last follow-up. None of the patient developed any other complications or required revision surgery.ConclusionsIntraoperative fracture during TKA, although rare but a significant complication which can affect the outcome, if not managed properly. We have shown methods of management for such cases, which have given excellent results.
| S-EPMC6492217 | biostudies-literature
Project description:We report the case of a 78-year-old woman with lateral knee osteoarthritis and severe valgus knee deformity after high tibial osteotomy. The patient's severe valgus tibial deformity with a valgus angle of 45° was evaluated using a 3-dimensional bone model, and a closing-wedge osteotomy was planned. Combined total knee arthroplasty and closing-wedge tibial osteotomy were performed using patient-specific instrumentation and a computed tomography-based navigation system. A semiconstrained total knee system with a long stem was implanted for fixation of the osteotomy site in the tibia. The patient was able to walk without pain 2 years postoperatively. The Knee Society Score improved from 13 to 73 points, and the functional score improved from 30 to 65 points. This preoperative planning method and the treatment procedure would be beneficial for clinical decision-making and treatment of severe valgus knee deformities.
| S-EPMC7476213 | biostudies-literature
Project description:BackgroundTotal knee arthroplasty using patient-specific instrumentation (TKA-PSI), which are disposable cutting block guides generated to fit each patient's 3-dimensional knee anatomy, has been developed to treat patients with end-stage osteoarthritis of the knee. Surrogate markers such as radiographic malalignment have been well investigated, however, patient-important outcomes are not well examined to elucidate the efficacy of TKA-PSI. The aim of this review is to determine if TKA-PSI improves patient-reported outcome measures (PROM), surgery time, blood loss, transfusion and complications (e.g. surgical site infection, deep venous thrombosis, and revision TKA).MethodsWe searched the Cochrane Central Register of Controlled Trials (CENTRAL), MEDLINE, EMBASE, and ongoing clinical trials. For PROMs, surgery time, blood loss, and transfusion rate, we included randomized controlled trials (RCT) comparing TKA-PSI and standard TKA to treat osteoarthritis of the knee. For complications, we also included non-randomized comparative studies (non-RCT).ResultsThis review includes 38 studies, 24 of which were RCT and 14 of which were non-RCT. These included a total of 3487 patients. The predominant population in the included studies highly reflected the general population, with 62% being female, aged over 60 and having end-stage osteoarthritis of the knee. TKA-PSI did not improve PROMs as compared to standard TKA for less than 1-year (mean difference 0.48, 95% confidence interval (CI) -1.92-0.97 in the Oxford knee score, mean 3-month follow-up) and for 1-year or more (mean difference 0.25, 95%CI - 4.39-4.89 in the WOMAC score, mean 29-month follow-up). TKA-PSI did not reduce surgery time (mean difference - 3.09 min, 95%CI -6.73-0.55). TKA-PSI decreased blood loss with a small effect size corresponding to a 0.4 g/dl hemoglobin decrease (95%CI 0.18-0.88), but did not decrease transfusion rate (risk difference - 0.04, 95%CI -0.09-0.01). TKA-PSI did not reduce complication rates (risk difference 0.00, 95%CI - 0.01-0.01 in the composite outcome).ConclusionsTKA-PSI does not improve patient-reported outcome measures, surgery time, and complication rates as compared to standard TKA. TKA-PSI decreases blood loss with a small effect, which is not enough to reduce transfusion rate.
| S-EPMC6875166 | biostudies-literature
Project description:Background There is no consensus on whether unicompartmental arthroplasty (UKA) or high tibial osteotomy (HTO) is superior for unicompartmental arthritis. While there are studies comparing revision and complication rates, none matched a large number of patients undergoing HTO and UKA in the United States and compared these outcomes. We investigated TKA conversion rate and the complications following HTO or UKA. Methods This retrospective study queried the PearlDiver database of all patients undergoing UKA and HTO using CPT codes between January 2011 and January 2020. We compared propensity-matched populations based on age, gender, Charlson comorbidity index, and Elixhauser comorbidity index to compare odds of complications, TKA conversion, and drug use between UKA and HTO groups. Two-independent sample t-test for unequal variances and test of significance were performed. Results We found 32,583 UKA patients and 816 HTO patients. Each matched group had 535 patients. One-year complication showed higher risk of pneumonia, hematoma, infection, and mechanical complications among HTO patients. UKA patients used narcotics on average of 10.3 days compared to 9.1 days among HTO patients (P < .01). UKA conversion rates were 4.1%, 5.4%, 7.7%, and 9.2% at 1-, 2-, 5-, and 10-year intervals, respectively. HTO conversion rates were less than 2% at 1- and 2-year intervals, 3.4% at 5-year, and 4.5% at 10-year intervals. This difference was statistically significant at 5- and 10-year intervals (P < .01). Conclusions Using large matched cohorts, HTO may be converted to TKA later than UKA in short- to mid-term follow-up, and HTO patients used opioids for shorter duration.
| S-EPMC10104836 | biostudies-literature
Project description:Ischaemic preconditioning is a method of protecting tissue against ischaemia-reperfusion injury. It is an innate protective mechanism that increases a tissue's tolerance to prolonged ischaemia when it is first subjected to short burst of ischaemia and reperfusion. It is thought to provide this protection by increasing the tissue's tolerance to ischaemia, therby reducing oxidative stress, inflammation and apoptosis in the preconditioned tissue. We used microarrays to investigate the genomic response induced by ischaemic preconditioning in muscle biopsies taken from the operative leg of total knee arthroplasty patients in order to gain insight into the ischaemic preconditioning mechanism. Patients undergoing primary knee arthroplasty were randomised to control and treatment (ischaemic preconditioning) groups. Patients in the treatment group received a preconditioning stimulus immediately prior to surgery. The ischaemic preconditioning stimulus consisted of three five-minute periods of tourniquet insufflation on the lower operative limb, interrupted by five minute periods of reperfusion. All patients had a tourniquet applied to the lower limb after the administration of spinal anaesthesia, as per normal protocol for knee arthroplasty surgery. Muscle biopsies were taken from the quadriceps muscle of the operative knee at the immediate onset of surgery (T0) and at 1 hour into surgery (T1). Total RNA was extracted from biospies of four control and four treatment patients and hybridised to the Affymetrix Human U133 2.0 chip.
2010-04-12 | E-GEOD-21164 | biostudies-arrayexpress
Project description:BACKGROUND:The purpose of this study was to compare restoration of mechanical limb alignment and three-dimensional component-positioning between conventional and patient-specific instrumentation in total knee arthroplasty. METHODS:Radiographic data of patients undergoing mobile-bearing total knee arthroplasty (n = 1257), using either conventional (n = 442) or patient-specific instrumentation (n = 812), were analyzed. To evaluate accuracy of axis restoration and 3D-component-positioning between conventional and patient-specific instrumentation, absolute deviations from the targeted neutral mechanical limb alignment and planned implant positions were determined. Measurements were performed on standardized coronal long-leg and sagittal knee radiographs. CT-scans were evaluated for accuracy of axial femoral implant rotation. Outliers were defined as deviations from the targeted neutral mechanical axis of > ±?3° or from the intraoperative component-positioning goals of > ±?2°. Deviations greater than ±?5° from set targets were considered to be severe outliers. RESULTS:Deviations from a neutral mechanical axis (conventional instrumentation: 2.3°± 1.7° vs. patient-specific instrumentation: 1.7°± 1.2°; p < 0.001) and numbers of outliers (conventional instrumentation: 25.8% vs. patient-specific instrumentation: 10.1%; p < 0.001) were significantly lower in the patient-specific instrumentation group. Significantly lower mean deviations and less outliers were detected regarding 3D-component-positioning in the patient-specific instrumentation compared to the conventional instrumentation group (all p < 0.05). CONCLUSIONS:Patient-specific instrumentation prevented from severe limb malalignment and component-positioning outliers (> ±?5° deviation). Use of patient-specific instrumentation proved to be superior to conventional instrumentation in achieving more accurate limb alignment and 3D-component positioning, particularly regarding femoral component rotation. Furthermore, the use of patient-specific instrumentation successfully prevented severe (>?5° deviation) outliers.
| S-EPMC6909617 | biostudies-literature
Project description:BACKGROUND:Postoperative stroke is a rare but potentially devastating complication following total hip arthroplasty (THA) and total knee arthroplasty (TKA). The purpose of the current study was to determine the incidence, independent risk factors, and timing of stroke following THA and TKA utilizing the National Surgical Quality Improvement (NSQIP) database. METHODS:Patients who underwent elective primary THA and TKA were identified in the 2005-2016 NSQIP database. Thirty-day postoperative strokes were identified, timing was characterized, and an incidence curve was created. Multivariate analyses determined the independent predictors of these strokes. RESULTS:Of 333,117 patients identified, 286 (0.09%) experienced a stroke. Given that THA vs TKA was not a univariate predictor of stroke, the two procedures were considered together. The majority (65%) of strokes occurred before discharge. Of the strokes observed, 25% occurred by postoperative day one, 50% by postoperative day two, and 75% by postoperative day nine. Independent risk factors for postoperative stroke were: age (60-69 years old odds ratio [OR] = 4.2; 70-79 years old OR = 8.1; ?80 years old OR = 16.1), higher American Society of Anesthesiologists (ASA) score (ASA?3 OR = 1.7), and smoking [OR = 1.6). CONCLUSION:The incidence of stroke after THA/TKA was low at 0.09%, with the majority occurring prior to discharge and half occurring by postoperative day two. Patients who were older, sicker, or who were smokers were at greater risk of postoperative stroke. These findings can be used to council patients and to optimize patient care. LEVEL OF EVIDENCE:Level III, Retrospective comparative study.
| S-EPMC7498016 | biostudies-literature